Impact of Medicare Part D on Racial Disparities in Diabetes Treatment and Outcome

医疗保险 D 部分对糖尿病治疗和结果中种族差异的影响

• 批准号: 7560147
• 负责人: JULIE Marie DONOHUE
• 金额: $ 18.03万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7560147
• 关键词: Impact; Medicare; Part; Racial; Disparities

DESCRIPTION (provided by applicant): Many older adults respond to high out-of-pocket drug costs by skipping, reducing dosages of or not filling prescriptions for their medications. A primary goal of the new Medicare drug benefit (Part D) was to increase the availability of drug coverage and thereby improve medication use among older adults. Medicare Part D may have a disproportionate impact on medication use among beneficiaries in minority groups. For instance, African American beneficiaries have enrolled in Part D in greater numbers (62% vs. 48%) than Caucasian beneficiaries. Moreover, African American beneficiaries are more likely than Caucasian beneficiaries to qualify for generous Part D low-income subsidies. As a result, Part D may help to alleviate racial/ethnic disparities in clinical processes of care and health outcomes that have been documented for a range of chronic conditions among older adults. We will assess the impact of Part D on racial disparities in medication use and health outcomes for older adults with diabetes, a chronic condition with increasing prevalence. Given the worse glycemic control and higher diabetes-related mortality among African Americans compared to Caucasians, our proposed investigations have critical implications for health disparities. The long-term objective of our proposed study is to reduce racial/ethnic disparities in health by examining the impact of changes in insurance coverage among the elderly. This proposal has two primary objectives. First, we will assess racial differences in antidiabetic medication use, glycemic control, and diabetes-related hospitalizations and mortality for an elderly cohort with diabetes before the implementation of Part D. We hypothesize that older African American beneficiaries with diabetes will have lower levels of antidiabetic medication use, worse glycemic control, and higher diabetes-related hospitalization and mortality rates compared to Caucasian beneficiaries. Second, we will examine whether Part D mitigates racial disparities in medication use, glycemic control, and diabetes-related hospitalizations and mortality in the elderly. We hypothesize that older African Americans compared to Caucasians will experience a larger improvement in medication use, glycemic control, and diabetes-related hospitalizations and mortality. Our study will use longitudinal data from an 11-year, Medicare population-based prospective cohort study. We will adjust our estimates of the effect of race and Part D for socioeconomic status, comorbidities, health, functional and cognitive status, access to care, and other factors. Our research has important policy implications. Medicare Part D -- the most substantial expansion of insurance benefits to older adults since the program's inception over 40 years ago -- is projected to cost just under $1 trillion between 2007 and 2017. If Medicare Part D reduces racial disparities in medication access, our study will inform other efforts to expand insurance coverage to vulnerable populations. Our multidisciplinary research team has extensive experience conducting health policy analyses, pharmacoepidemiologic studies with geriatric populations, health disparities and diabetes research, and is uniquely positioned to shed light on this critical policy issue.

描述（由申请人提供）：许多老年人通过跳过，减少剂量或不填写他们的药物处方来应对高额的自付药物费用。新的医疗保险药物福利（D部分）的主要目标是增加药物覆盖的可用性，从而改善老年人的药物使用。医疗保险D部分可能对少数群体受益人的药物使用产生不成比例的影响。例如，非裔美国人受益人参加D部分的人数（62%对48%）高于白人受益人。此外，非裔美国人受益人比高加索人受益人更有可能有资格获得慷慨的D部分低收入补贴。因此，D部分可能有助于缓解临床护理过程中的种族/民族差异和已记录的一系列慢性疾病的健康结果 在老年人中。我们将评估D部分对患有糖尿病（一种患病率不断上升的慢性病）的老年人在药物使用和健康结果方面的种族差异的影响。鉴于非裔美国人与白人相比血糖控制较差，糖尿病相关死亡率较高，我们提出的研究对健康差异具有重要意义。我们拟议研究的长期目标是通过研究老年人保险范围变化的影响，减少种族/民族健康差异。这项建议有两个主要目标。首先，我们将评估在D部分实施前，老年糖尿病患者队列在抗糖尿病药物使用、血糖控制、糖尿病相关住院和死亡率方面的种族差异。我们假设，与白人受益人相比，患有糖尿病的老年非裔美国人受益人的抗糖尿病药物使用水平较低，血糖控制较差，糖尿病相关住院率和死亡率较高。其次，我们将研究D部分是否减轻了老年人在药物使用、血糖控制、糖尿病相关住院和死亡率方面的种族差异。我们假设，与白种人相比，老年非裔美国人在药物使用、血糖控制、糖尿病相关住院和死亡率方面会有更大的改善。我们的研究将使用一项为期11年的基于医疗保险人群的前瞻性队列研究的纵向数据。我们将根据社会经济地位、合并症、健康、功能和认知状态、获得护理的机会和其他因素调整对种族和D部分影响的估计。我们的研究具有重要的政策意义。医疗保险D部分-自40多年前该计划成立以来对老年人保险福利的最大幅度扩展-预计在2007年至2017年期间将花费不到1万亿美元。如果医疗保险D部分减少了药物获得方面的种族差异，我们的研究将为其他努力提供信息，以扩大对弱势群体的保险覆盖范围。我们的多学科研究团队在开展卫生政策分析、老年人群药物流行病学研究、健康差异和糖尿病研究方面拥有丰富的经验，在阐明这一关键政策问题方面具有独特的优势。